Central venous catheter‐related thrombosis and thromboprophylaxis in children: a systematic review and meta‐analysis: reply

Abstract

children to thromboprophylaxis is justifiable against the natural history of CVC-related DVT. We argue that natural history studies that prospectively follow patients with a CVC in situ with concurrent objective imaging and long-term evaluation of clinical outcomes, such as PTS, are the logical next step in developing appropriate clinical management. AddendumAll authors read the paper by Vidal et al. This Letter to the Editor was drafted by S. Jones and F. Newall, with review and editing by V. Ignjatovic and P. Monagle. Disclosure of Conflict of InterestsThe authors state that they have no conflict of interests. Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis: reply We appreciate the insightful comments of Jones and colleagues regarding our systematic review of central venous catheter-related thrombosis and thromboprophylaxis in children [1]. They raised two important points that we would like to address. References

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

“…Although children, in general, have lower risks for VTE, it seems to be least common with umbilical venous catheters and PICC lines. The risk appears similar in both upper and lower extremities 46 . Again, the risks and benefits of CVC placement must be considered prior to placement in children.…”

Deep vein thrombosis in pediatric patients

“…Studies are contradictory as to which type of CVC, insertion technique, or catheter material has the highest risk for DVT development. A meta‐analysis found that DVT rates were lowest in patients who had PICCs and umbilical lines (versus tunneled lines), without a difference in DVT rates between CVCs placed in the upper or lower extremity . Conversely, a systematic review found tunneled lines (versus nontunneled and PICCs) to have the lowest rate of DVT …”

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

“…Securing reliable venous access is of paramount importance when considering parenteral nutrition (PN). However, the presence of a central venous catheter (CVC) is the principal risk factor for major, potentially lethal complications, such as nosocomial bloodstream infection [1] and venous thrombosis [2]. Moreover, the most important risks associated with complications arising from the use of CVC are administration of PN, young age and extended use (long indwelling time) [3e5].…”